Provider Demographics
NPI:1932446440
Name:ERICKSON, PRISCILLA E (RN)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:E
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SANDY REACH
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5819
Mailing Address - Country:US
Mailing Address - Phone:508-524-5801
Mailing Address - Fax:
Practice Address - Street 1:34 SANDY REACH
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5819
Practice Address - Country:US
Practice Address - Phone:508-524-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN241145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse